Certain medications require prior authorization. Your pharmacist will help you arrange for these drugs. Physicians must call Express Scripts.
Express Scripts
(800) 753-2851 — Physicians only
Oncology Treatment: Call eviCore at (888) 910-1199
Express Scripts’ prior authorization (PA) policies include the brand medication and any available generics for that brand.
Benefit Fund
(646) 473-7446
Drug Classes Requiring Approval by Benefit Fund
- Factor VIII blood factor products
- Rare diseases (e.g. Fabry’s Disease, Gaucher’s Disease)
Click here for a complete list.
Subject to Change
Drugs Requiring Prior Authorization Effective January 2017
| Drug Target | Therapy Class |
|---|---|
| Abstral | Pain - Narcotic |
| Accolate | Asthma/COPD |
| Actemra IV | Inflammatory Conditions |
| Actemra SC | Inflammatory Conditions |
| Actiq | Pain - Narcotic |
| Adcirca | Pulmonary Hypertension |
| Adderall XR | Attention Disorders |
| Adempas | Pulmonary Hypertension |
| Adipex | Weight Loss |
| amphetamine sulfate | Attention Disorders |
| Ampyra | Multiple Sclerosis |
| anabolic steroid | Hormone Supplementation |
| Androderm | Endocrine Disorder |
| AndroGel | Endocrine Disorder |
| Aptensio XR | Attention Disorders |
| Aralast NP | Metabolic, Immune Disorders or Inherited Rare Disease |
| Aranesp | Blood Cell Deficiency |
| Arcalyst | Metabolic, Immune Disorders or Inherited Rare Disease |
| Atralin gel | Skin Conditions |
| Aubagio | Multiple Sclerosis |
| Aveed | Endocrine Disorder |
| Avita | Skin Conditions |
| Avonex | Multiple Sclerosis |
| Axiron | Endocrine Disorder |
| Belviq | Weight Loss |
| Benlysta | Metabolic, Immune Disorders or Inherited Rare Disease |
| Berinert | Metabolic, Immune Disorders or Inherited Rare Disease |
| Betaseron, Extavia | Multiple Sclerosis |
| Bivigam | Metabolic, Immune Disorders or Inherited Rare Disease |
| Bontril | Weight Loss |
| Botox | Neurological Disorders |
| Brand Singulair | Asthma/COPD |
| Bunavail | Pain - Narcotic |
| Butrans | Pain - Narcotic |
| Bydureon | Diabetes |
| Byetta | Diabetes |
| Carimune | Metabolic, Immune Disorders or Inherited Rare Disease |
| Caverject | Impotence |
| Caverject Impluse | Impotence |
| Cayston | Anti-infectives |
| Chenodal | Metabolic, Immune Disorders or Inherited Rare Disease |
| Cholbam | Metabolic, Immune Disorders or Inherited Rare Disease |
| Cimzia | Inflammatory Conditions |
| Cinqair | Asthma Specialty |
| Cinryze | Metabolic, Immune Disorders or Inherited Rare Disease |
| Concerta | Attention Disorders |
| Contrave | Weight Loss |
| Copaxone | Multiple Sclerosis |
| Copegus | Hepatitis C |
| Cosentyx | Inflammatory Conditions |
| Daklinza | Hepatitis C |
| Daliresp | Blood Cell Deficiency |
| Daytrana | Attention Disorders |
| Delatestryl | Endocrine Disorder |
| Depo - Testosterone | Endocrine Disorder |
| Desoxyn | Attention Disorders |
| Dexedrine Spansules | Attention Disorders |
| dexmethylphenidate HCL | Attention Disorders |
| dextroamphetamine sulfate | Attention Disorders |
| dextroamphetamine sulfate tablets | Attention Disorders |
| diclofenac sodium | Skin Conditions |
| Didrex | Weight Loss |
| Dificid | Anti-Infectives |
| Dyanavel XR | Attention Disorders |
| Dysport | Neurological Disorders |
| Edex | Impotence |
| Egrifta | Endocrine Disorder |
| Eligard | Endocrine Disorder |
| Enbrel | Inflammatory Conditions |
| Entresto | Heart Failure |
| Entyvio | Inflammatory Conditions |
| Epclusa | Hepatitis C |
| Epogen | Blood Cell Deficiency |
| epoprostenol sodium | Pulmonary Hypertension |
| Esbriet | Respiratory Miscellaneous |
| Euflexxa | Osteoarthritis |
| Evekeo | Attention Disorders |
| Eylea | Eye Conditions |
| Fabior 0.1% foam | Skin Conditions |
| fentanyl | Pain - Narcotic |
| Fentora | Pain - Narcotic |
| Ferriprox | Metabolic, Immune Disorders or Inherited Rare Disease |
| Firazyr | Metabolic, Immune Disorders or Inherited Rare Disease |
| First - Testosterone | Endocrine Disorder |
| First - Testosterone MC | Endocrine Disorder |
| Flebogamma DIF | Metabolic, Immune Disorders or Inherited Rare Disease |
| Flolan | Pulmonary Hypertension |
| Focalin | Attention Disorders |
| Focalin XR | Attention Disorders |
| Forteo | Bone Conditions |
| Fortesta | Endocrine Disorder |
| Gabitril | Neurological Disorders |
| Gammagard | Metabolic, Immune Disorders or Inherited Rare Disease |
| Gammagard Liquid | Metabolic, Immune Disorders or Inherited Rare Disease |
| Gammagard S/D | Metabolic, Immune Disorders or Inherited Rare Disease |
| Gammaked | Metabolic, Immune Disorders or Inherited Rare Disease |
| Gammaplex | Metabolic, Immune Disorders or Inherited Rare Disease |
| Gamunex | Metabolic, Immune Disorders or Inherited Rare Disease |
| Gamunex-C | Metabolic, Immune Disorders or Inherited Rare Disease |
| Gel-One | Osteoarthritis |
| Genotropin | Endocrine Disorder |
| Gilenya | Multiple Sclerosis |
| Glassia | Metabolic, Immune Disorders or Inherited Rare Disease |
| Glatopa | Multiple Sclerosis |
| Granix | Blood Cell Deficiency |
| Grastek | Allergies |
| H.P. Acthar Gel | Metabolic, Immune Disorders or Inherited Rare Disease |
| Harvoni | Hepatitis C |
| Hetlioz | Sleep Disorder |
| Hizentra | Metabolic, Immune Disorders or Inherited Rare Disease |
| Humatrope | Endocrine Disorder |
| Humira | Inflammatory Conditions |
| Hyalgan | Osteoarthritis |
| Hymovis | Osteoarthritis |
| Hyqvia | Metabolic, Immune Disorders or Inherited Rare Disease |
| ibandronate sodium | Bone Conditions |
| Ilaris | Metabolic, Immune Disorders or Inherited Rare Disease |
| Increlex | Endocrine Disorder |
| Inflectra | Inflammatory Conditions |
| Kalbitor | Metabolic, Immune Disorders or Inherited Rare Disease |
| Kalydeco | Respiratory Miscellaneous |
| Keveyis | Metabolic, Immune Disorders or Inherited Rare Disease |
| Kineret | Inflammatory Conditions |
| Korlym | Endocrine Disorder |
| Krystexxa | Gout |
| Kuvan | Metabolic, Immune Disorders or Inherited Rare Disease |
| Lazanda | Pain - Narcotic |
| Lemtrada | Asthma/COPD |
| Letairis | Pulmonary Hypertension |
| lidocaine | Pain |
| lisdexamfetamine dim | Attention Disorders |
| Lovaza | High Blood Cholesterol |
| Lucentis | Eye Conditions |
| Lupaneta | Endocrine Disorder |
| Lupron Depot | Endocrine Disorder |
| Lupron Depot-Ped | Endocrine Disorder |
| Macugen | Eye Conditions |
| Makena | Hormone Supplementation |
| Metadate CD | Attention Disorders |
| Metadate ER | Attention Disorders |
| Methylin | Attention Disorders |
| methylphenidate | Attention Disorders |
| methylphenidate ER | Attention Disorders |
| methylphenidate HCL | Attention Disorders |
| Mircera | Blood Cell Deficiency |
| modafinil | Narcolepsy |
| Moderiba | Hepatitis C |
| Monovisc | Osteoarthritis |
| Muse | Impotence |
| Myalept | Endocrine Disorder |
| Myobloc | Neurological Disorders |
| Natpara | Endocrine Disorder |
| Neulasta | Blood Cell Deficiency |
| Neupogen | Blood Cell Deficiency |
| Norditropin | Endocrine Disorder |
| Northera | Neurological Disorders |
| Nplate | Metabolic, Immune Disorders or Inherited Rare Disease |
| Nucala | Asthma Specialty |
| Nuedexta | Neurological Disorders |
| Nutropin | Endocrine Disorder |
| Nutropin AQ | Endocrine Disorder |
| Nuvigil | Narcolepsy |
| Ocaliva | Metabolic, Immune Disorders or Inherited Rare Disease |
| Octagam | Metabolic, Immune Disorders or Inherited Rare Disease |
| Ofev | Respiratory Miscellaneous |
| Olysio | Hepatitis C |
| Omnitrope | Endocrine Disorder |
| Onsolis | Pain - Narcotic |
| Opsumit | Pulmonary Hypertension |
| Oralair | Allergies |
| Orencia | Inflammatory Conditions |
| Orenitram | Pulmonary Hypertension |
| Orkambi | Respiratory Miscellaneous |
| Orthovisc | Osteoarthritis |
| Otezla | Inflammatory Conditions |
| Pegasys | Hepatitis C |
| PegIntron | Hepatitis C |
| Plegridy | Multiple Sclerosis |
| Praluent | High Blood Cholesterol |
| Privigen | Metabolic, Immune Disorders or Inherited Rare Disease |
| Procentra | Attention Disorders |
| Procrit | Blood Cell Deficiency |
| Prolastin | Metabolic, Immune Disorders or Inherited Rare Disease |
| Prolastin C | Metabolic, Immune Disorders or Inherited Rare Disease |
| Prolia | Bone Conditions |
| Promacta | Metabolic, Immune Disorders or Inherited Rare Disease |
| Qsymia | Weight Loss |
| Quillichew ER | Attention Disorders |
| Quillivant XR | Attention Disorders |
| Ragwitek | Allergies |
| Rebetol | Hepatitis C |
| Rebif | Multiple Sclerosis |
| Relistor | Pain - Narcotic |
| Remicade | Inflammatory Conditions |
| Remodulin | Pulmonary Hypertension |
| Repatha | High Blood Cholesterol |
| Restasis | Eye Conditions |
| Retin-A | Skin Conditions |
| Retin-A Micro | Skin Conditions |
| Revatio | Pulmonary Hypertension |
| Ribasphere | Hepatitis C |
| Ritalin | Attention Disorders |
| Ritalin LA | Attention Disorders |
| Ritalin SR | Attention Disorders |
| Rituxan | Inflammatory Conditions |
| Ruconest | Metabolic, Immune Disorders or Inherited Rare Disease |
| Saizen | Endocrine Disorder |
| Saxenda | Weight Loss |
| Selzentry | HIV |
| Sensipar | Endocrine Disorder |
| Serostim | Endocrine Disorder |
| Signifor/Signifor LAR | Endocrine Disorder |
| Simponi | Inflammatory Conditions |
| Sovaldi | Hepatitis C |
| Stelara | Inflammatory Conditions |
| Striant | Endocrine Disorder |
| Suboxone | Pain - Narcotic |
| Subsys | Pain - Narcotic |
| Supartz | Osteoarthritis |
| Suprenza | Weight Loss |
| Symlin | Diabetes |
| Synagis | Respiratory Miscellaneous |
| Synvisc | Osteoarthritis |
| Synvisc-One | Osteoarthritis |
| Syprine | Metabolic, Immune Disorders or Inherited Rare Disease |
| Taltz | Inflammatory Conditions |
| Tanzeum | Diabetes |
| Tazorac 0.05% and 0.1% cream, gel | Skin Conditions |
| Tecfidera | Multiple Sclerosis |
| Technivie | Hepatitis C |
| Tenuate | Weight Loss |
| Testim | Endocrine Disorder |
| Testopel | Endocrine Disorder |
| tetrabenazine | Neurological Disorders |
| topiramate | Neurological Disorders |
| Tracleer | Pulmonary Hypertension |
| tretinoin topical products | Skin Conditions |
| Tretin X | Skin Conditions |
| Trulicity | Diabetes |
| Tysabri | Multiple Sclerosis |
| Tyvaso | Pulmonary Hypertension |
| Uptravi | Pulmonary Hypertension |
| Vascepa | High Blood Cholesterol |
| Veltin | Skin Conditions |
| Ventavis | Pulmonary Hypertension |
| Victoza | Diabetes |
| Viekira | Hepatitis C |
| Vpriv | Metabolic, Immune Disorders or Inherited Rare Disease |
| Vyvanse | Attention Disorders |
| Xeljanz | Inflammatory Conditions |
| Xeljanz XR | Inflammatory Conditions |
| Xenical | Weight Loss |
| Xeomin | Neurological Disorders |
| Xiidra | Eye Conditions |
| Xolair | Asthma Specialty |
| Zarxio | Blood Cell Deficiency |
| Zavesca | Metabolic, Immune Disorders or Inherited Rare Disease |
| Zemaira | Metabolic, Immune Disorders or Inherited Rare Disease |
| Zenzedi | Attention Disorders |
| Zepatier | Hepatitis C |
| Ziana | Skin Conditions |
| Zinbryta | Multiple Sclerosis |
| zoledronic acid/mannitol & water | Bone Conditions |
| Zomacton | Endocrine Disorder |
| Zorbtive | Endocrine Disorder |
| Zubsolv | Pain - Narcotic |
| Zyflo | Asthma/COPD |
| Zyflo CR | Asthma/COPD |
